RU2564962C1 - Method of treating cicatrical enroption combined with trichiasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: eyelid cartilage plate is incised through in parallel with an eyelid inner costal margin; the wound is extended until enroption is eliminated completely, and a natural anatomical position of the eyelid and the eye lashes is restored. A cartilage defect is replaced by an implant of the biomaterial "Alloplant for Blepharoplasty" cut out in size of the defect. The implant is covered with a flap of labial autologous mucosa in size 2-3 mm more than that of the implant.

EFFECT: invention is expected to increase the effectiveness of the method by elongating the posterior eyelid cartilage plate that provides eliminating enroption and trichiasis and repositioning the eyelid and the eye lashes in accordance with their natural anatomy.

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Description

The invention relates to medicine, namely to ophthalmic surgery, and is intended for the treatment of cicatricial inversion-trichiasis of the eyelid.

Cicatricial inversion of the eyelid and trichiasis can be the result of trachoma, as well as trauma or a deep burn of the conjunctiva and cartilage of the eyelid. There are various surgical methods for eliminating cicatricial inversion of the eyelid, the essence of which is the thinning of the cartilage of the eyelid by applying incisions or excising part of the cartilage with subsequent suturing in order to “straighten” the cartilage (A. Kolen. Manual on plastic surgery in the eye area.- M. : Medgiz, 1950, p. 162, 173, A. Kolen. A multivolume guide to eye diseases, vol. IV, M.: Medgiz, 1959). Since during cicatricial inversion of the cartilage of the eyelid, the width is shorter than normal, and also deformed and atrophic, the disadvantages of these surgical methods include the fact that they do not contribute to cartilage lengthening and restoration of the skeleton properties of the eyelid. Proposed at the end of the 19th century K.M. Sapezhko transplantation of the mucous membrane of the lips for the treatment of eyelid inversion and trichiasis, often encountered while the consequences of trachoma, is still the basis for modern surgical techniques to eliminate eyelid inversion (Sapezhko K.M. Clinical materials on the issue of transplantation of the mucous membrane. Diss. , Kiev, 1892).

A known method of surgical treatment of cicatricial inversion of the eyelid by transplanting a flap of the mucous membrane of the lips (CD McCord. Oculoplastic Surgery. 2 ^nd ed, 1987. Raven Press. NY pp. 297-301). According to the method, an eyelid edge is cut along the border of the skin and the mucosa, the eyelid is split into two plates, the front plate is mobilized relative to the back, the exposed wound surface is closed with a full-layer flap of the mucous lip. The disadvantages of the method include the formation of a round unformed rear rib, which subsequently develops a relapse inversion, in addition, the eyelashes as a result of the operation do not take their natural position.

There is a method of surgical treatment of recurrent inversion of the eyelids, which consists in changing the shape of the deformed cartilage by cutting and separating the skin of the eyelid, stitching with allotriginous threads of the separated skin flap, while capturing the skin dermis at the roots of the eyelashes and the opposite edge of the cartilage of the eyelid, the seams alternately bind and bend the cartilage in the opposite side of the eyeball, after which the skin incision is sutured (USSR author's certificate No. 1261653, IPC A61F 9/00, publ. 07.10.1986). However, the known method may not be effective enough for total inversion (throughout the century), as well as when combining inversion with trichiasis, since eliminating trichiasis only by changing the shape of the cartilage without lengthening it is impossible.

A known method of treating cicatricial marginal inversion of the eyelid, according to which the eyelid is split into two plates, a step flap with a full-layer part to the entire thickness of the mucous lip and a split part to half the thickness of the mucous lip is separately cut out on the mucous membrane of the eyelid, the flap is laid in a full-layer part on the wound surface of the anterior plate of the eyelid , split part - on the intermarginal space of the century (RF patent No. 2126237, IPC A61F 9/00, publ. 02.20.1999).

The disadvantage of this method lies in its limited capabilities - the use only for the treatment of regional cicatricial inversion of the eyelid. The auto-mucous membrane of the lip is a soft material and does not carry a skeleton function, and to eliminate cicatricial deformation of the cartilage, which is the skeleton of the eyelid, it is necessary to use a more dense material that has a supporting function similar to cartilage.

The technical result of the invention is to increase the efficiency of the method by lengthening the posterior cartilaginous plate of the eyelid, which eliminates inversion and trichiasis and the natural anatomical position of the eyelid and eyelashes.

The technical result is achieved by a method of treating cicatricial inversion-trichiasis of the upper eyelid, including a through incision of the posterior cartilaginous plate of the eyelid parallel to the inner costal edge of the eyelid, widening the wound to completely eliminate the inversion of the eyelid and restoring the natural anatomical position of the eyelid and eyelashes, subsequent replacement of a cartilage defect with an implant from Alloplant biomaterial for eyelid plasty, cut according to the size of the defect, and covering the implant with a flap from the autosmucous membrane of the lip, exceeding it in size by 2-3 m.

The specified technical result is achieved through the use of the well-known Alloplant biomaterial for eyelid plasty (information letter Moscow-Ufa-2004, p. 18). The unique regenerative properties of Alloplant biomaterial (patent RF №2189257, A61L 27/00, published on September 20, 2002) provide good survival of the implant in the cartilaginous cleavage of the eyelid. Thus, a full-fledged eyelid frame is created with its correct anatomical position, eliminating inversion-trichiasis of the upper eyelid.

The invention is illustrated by illustrations, where in FIG. 1, 2 shows the sequence of operations and is indicated: 1 - inverted upper eyelid with an area of inversion and trichiasis 2, 3 - Eger's plate, 4 - incision, 5 - implant, 6 - flap from an autosmucous lip.

The method is as follows.

Eyelid 1 is taken on the stitches-holders and turned on the plate of Jäger 3. In the area of inversion and trichiasis 2, departing from the inner costal margin of the eyelid by 2 mm, a through linear incision of 4 cartilage of the eyelid is parallel to the edge of the eyelid. The wound is expanded to completely eliminate the inversion of the eyelid and restore the natural anatomical position of the eyelashes, that is, to eliminate trichiasis. The resulting eyelid cartilage defect is replaced with an implant 5 from Alloplant biomaterial for eyelid plasty, cut to the size of a cartilage defect, which is a very dense, but at the same time flexible material 1.5 mm thick. The implant is fixed to the cartilage of the eyelid with 4-6 interlocking 6/0 vicryl sutures, which are applied so that the needle sticks into the implant from bottom to top, then through its own cartilage along the edge of the defect from top to bottom so that the node remains in depth below the implant (total 6 nodal joints). On top of the implant, the conjunctival defect is covered with a flap 6 from the autosmucous membrane of the lip, which, given its ability to contract, should be 2-3 mm larger than the cartilage defect, which is a condition for successful epithelialization of the eyelid conjunctiva defect. The flap is sewn with a continuous seam of 8/0 vikril. The operation is completed with temporary blepharography from one central suture (Vicryl 5/0).

Clinical example 1. Patient M., 56 l. Diagnosis: Cicatricial inversion and trichiasis of the upper eyelid. The operation was carried out according to the proposed method: The upper eyelid was taken on a stitch-holder, turned on a plate of Eger. In the area of inversion and trichiasis, departing from the inner costal margin of the eyelid by 2 mm, a through linear incision was made of the cartilage of the upper eyelid parallel to the edge of the eyelid. The wound is expanded to the complete elimination of inversion and trichiasis. The resulting defect in the cartilage of the eyelid 6 × 18 mm in size is replaced by an implant from Alloplant biomaterial for plastic eyelids corresponding to a defect. The implant is fixed to the cartilage of the century with six interlocking sutures 6/0 Vicryl. On top of the implant, the conjunctival defect is covered with a flap of autosmucous lip size 8 × 20 mm. The flap is fixed with a continuous 8/0 vikril seam. Temporary blepharraphy was performed from one central suture (Vicryl 5/0). After 7 days, the central suture was removed, epithelization of the conjunctival wound was observed, the upper eyelid and ciliary edge had the correct anatomical position. The achieved effect was maintained in the long term 3, 6, 12 months after surgery.

Clinical example 2. Patient F., 8 years old. Diagnosis: Cicatricial inversion and trichiasis of the lower eyelid. The operation was performed: The lower eyelid was taken on a stitch-holder, turned out on the Eger plate. In the area of inversion and trichiasis, departing from the inner costal margin of the eyelid by 2 mm, a through linear incision was made of the cartilage of the upper eyelid parallel to the edge of the eyelid. The wound is expanded to the complete elimination of inversion and trichiasis. The resulting defect in the cartilage of the eyelid 5 × 16 mm in size is replaced by an implant from Alloplant biomaterial for plastic eyelids corresponding to a defect. The implant is fixed to the cartilage of the century with six interlocking sutures 6/0 Vicryl. On top of the implant, the conjunctival defect is covered with a flap of autosmucous lip 7 × 19 mm in size. The flap is fixed with a continuous 8/0 vikril seam. Temporary blepharraphy was performed from one central suture (Vicryl 5/0). After 7 days, the central suture was removed, epithelization of the conjunctival wound was noted, the lower eyelid and ciliary edge had the correct anatomical position. The achieved positive effect persisted two years after the operation.

Thus, the proposed invention allows to effectively eliminate cicatricial inversion-trichiasis of the century, providing its reliable and stable anatomical position.

Claims (1)

A method for treating cicatricial inversion in combination with trichiasis, including a through incision of the cartilaginous plate of the eyelid parallel to the inner costal margin of the eyelid, widening the wound to completely eliminate the inversion of the eyelid and restoring the natural anatomical position of the eyelid and eyelashes, subsequent replacement of the cartilage defect with the implant from the Alloplant for Eyelid Plastic , cut out according to the size of the defect, and covering the implant with a flap from the autosmucous membrane of the lip, exceeding it in size by 2-3 mm.

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